Monday, November 1, 2010

PSYCHOSIS by Chantal Tsotsos and Glenn Estrellado



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19. Alcohol, Drugs and Psychosis

    from http://www.unodc.org/images/odccp/26june0709/animated_logo.gif
  • Street drugs and/or alcohol are not a primary cause of psychosis; they may help to worsen symptoms, increase the person's vulnerability to relapses and rehospitalizations, and/or impair the protective effects of anti-psychotic medications.
  • Street drugs or alcohol can complicate the treatment of the person with psychosis because they may be more difficult to engage in treatment programs, vocational programs, or therapy. There are also financial, legal, health, housing, interpersonal, and family problems associated with a person with mental illness using street drugs and/or alcohol.
  • Dual diagnosis is defined as the combination of a major mental illness and a substance abuse disorder.
  • Person with psychosis may use drugs and/or alcohol due to:
Some family members may neglect to mention their relative's drug or alcohol abuse to health care professionals because they believe it is a symptom that will clear up once the person receives treatment for the mental illness.
Assessing alcohol and drug use:

    from http://www.capriogroup.com/webstuff/Images/AnimatedGIFs/Animated-CartoonDoctor.gif
  • If possible, discuss with your family member's mental health professional, doctor, etc. and consult on how you can help your family member or friend who is using alcohol and/or drugs.
  • Therapeutic approach is to avoid heavy confrontation and intense emotional interactions which can create additional stress and reactions in people with psychosis. A non-confrontational approach based on education, support, and discussion is more effective, especially in one-to-one and/or group setting. Avoid judgmental and/or blaming statements. Be willing to listen to the person rather than interpret behavior.
  • Talk to your family member and ask in a straight-forward, matter of fact way if they are using alcohol and/or drugs. However, denial of alcohol and/or drug use is no guarantee that your family member is not abusing.
  • Look for worsening of symptoms that cannot be accounted for by medication non-compliance or current life stressors.
    • 
    
    from http://i37.photobucket.com/albums/e65/KAGEnoSORA/Animation7.gif
  • Look for noticeable decline in functioning
    e.g.failing to meet expectations that were formerly met (being late, sleeping in, not doing house chores, etc)
  • Alcohol or drug paraphernalia (e.g. rolling papers, pipes, cut plastic tubes for snorting cocaine, small bags for storing drugs, etc)
    • from http://mindmillion.com/images/money/01-money-burn-anim.gif
  • Financial difficulties (i.e. not having any money or repeated efforts to borrow money from friends and families).
  • New set of friends in a short period of time.


END!
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18. Suicide

The following information was provided by Suicide Attempt Follow-up Education & Research Program (SAFER). 

WHERE TO LOOK FOR HELP



from http://i282.photobucket.com/albums/kk254/jacobhalstead123/Suicide/you-should-kill-yourself-animated.gif
SUICIDE FACTS: HOW TO RECOGNIZE SUICIDE RISK HOW TO HELP YOURSELF IF YOU ARE IN A SUICIDAL CRISIS
Many people think about suicide in their lives. You possibly have a friend or relative who has thought about suicide.You, too, may have occasional feelings of hopelessness. Suicide crosses all social, economic and cultural boundaries. A significant percentage of people who complete suicide appeared to be functioning well prior to their death. 
The rate for men over 65 is also high. Women have a lower rate of death by suicide, but current trends show their attempts are becoming more lethal.
Four out of five people who complete suicide have previously expressed suicidal thoughts. It is very important to take all suicide thoughts and attempts seriously:

    from http://www.graphicsgrotto.com/animatedgifs/alcohol/images/agalcohol1.gif
  • Direct or indirect statements about death or suicide. History of previous suicide attempts.
  • Recent traumatic loss (eg. Suicide death of a loved one)
  • Any sudden change in behaviour or mood (eg. From being talkative and outgoing to becoming withdrawn).
  • Depression (eg. crying, sleep and appetite disturbances, hopelessness).
  • Finalizing affairs (eg. giving away possessions, making a will or saying good-byes).
  • Increased use of drugs or alcohol.
You may be feeling confused and overwhelmed and believe you are in an unsolvable crisis. You are not alone.Others who have experienced emotional difficulties have been helped by reaching out to someone they trust or by talking to an experienced professional.
If you are in crisis, you deserve help.
LISTEN

  • Be aware of warning signs of suicide and take them seriously.
    • from http://www.free4-all.co.uk/assets/images/DontCry02.gif
  • Discuss feelings openly and frankly.
  • If you suspect they are suicidal ASK.
  • Discussion is the first step in giving help.
  • Show concern and understanding.
  • Get involved in efforts to reach out for help.
  • Be objective and nonjudgemental.
  • Share responsibility by encouraging involvement of family and close friends.
  • Help the person to focus on strengths rather than weaknesses.
With counseling you can:

FACT: Eight out of ten people who kill themselves give definite clues of suicidal feelings.

FACT: Suicidal people, even if they seem to have it all, may not feel okay about themselves. They feel they can't meet their own expectations.
FACT: Most suicidal people want to end their pain and see death as the only way out.
from http://www.gifanatics.com/files/henk%201.gif
FACT: Talking with them about suicide doesn't increase their risk. He or she will more likely feel a sense of relief that finally someone is allowing them an opportunity to talk.
FACT: Suicidal people feel hopeless, helpless, and worthless and usually require professional support.
FACT: Just because the suicidal person is unhappy, doesn't mean they are crazy.Most of us have felt despair at some time in our lives and may have been suicidal.

ARE THEY SUICIDAL?

CHECKLIST
What they're saying:
What's happening:
  • Relationship break-up
  • Family troubles
  • History of being abused or depressed
  • Feeling like a failure
  • Feeling like there's no place to turn for help
What you see:

HOW TO HELP
  1. Learn the common clues that may indicate that your friend is suicidal.
  2. Let them know you care about them and want to help.
  3. LISTEN, LISTEN, LISTEN.
    Ask questions about their feelings and let them do the talking.
  4. Ask the question: Has it been so bad that you've thought of killing yourself?
    5. from http://i563.photobucket.com/albums/ss75/LadySandee/best-friends27.gif
  5. Try not to judge or argue, just understand.
  6. If you think they might harm themselves right now, don't leave them alone. Contact someone for assistance.
  7. Ask for help, even if they've asked you not to tell anyone. Remember: BETTER AN ANGRY FRIEND THAN A DEAD FRIEND.
  8. Continue to offer support and stay in contact with the person.Get support for yourself too.
    9. from http://www.threadbombing.com/data/media/2/happykillmore2yp1.gif
  9. Don't promise to keep secrets or keep it confidential.Involve a trusted adult immediately. LISTEN, LISTEN, LISTEN
WHERE TO GO FOR HELP:
School: A favourite teacher/coach, a school counselor, a principal or vice-principal
A minister or rabbi
A trusted adult
Departments close to your home

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17. Aggression

Definition:
from http://nymag.com/daily/entertainment/2009/10/26/madmen1.gif
Verbal or physical acting out in a destructive, threatening or violent manner.
Causes:

A PAST HISTORY OF VIOLENCE AND AGGRESSION IS A PREDICTOR OF AGGRESSION
SUCCESSFUL LIMIT SETTING
Keep it simple:

  • Watch non-verbal behaviour
  • Provide room for the person so they don't feel crowded
Give choices:

Lower Stimulation:

  • Turn off radio and tv and stereo
  • Reduce room lights
  • Have one person appointed as spokesman
  • Have only 2 others in the room with you
Be Clear:

Enforceable:

Reasonable:

  • Be calm, factual, non-punitive
  • Target only important issues
  • Don't remind them of all the things they've done wrong in the past
  • Maintain safety
  • Avoid making it a public issue (don't discuss in front of a lot of other people)
  • Consider if the person will be able to follow through with what you've discussed
    • from http://i12.photobucket.com/albums/a210/JRuff/Art/smiley-big-speak.gif
  • Have a plan ahead of time if you can
  • After the incident, when the person is calm and able, discuss what happened and what changes might be made in the future to prevent a repeat

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16. Crises

from http://www.wiltshirehumangivens.org/resources/brain_animated.gif
Crisis is any type of situation that causes one to experience unusually strong emotional reactions.
This may interfere with your ability to function in your usual way.
You may find yourself:

It may be a mild reaction or a severe one, depending on what the actual crisis is and how well prepared you are in terms of resources and supports.
Having a family member or close friend with a psychiatric problem is usually an unexpected event in the family. Because this is a new situation you probably haven't developed efficient ways to cope and probably feel quite alone, confused and uncertain as to how to proceed.
THIS WEBSITE DISCUSSES THREE TYPES OF CRISES:






from http://i206.photobucket.com/albums/bb38/bucketBUCKETboom/Shark.gif



  • suicide 




















    • from http://www.bakerfamily4.net/kenpo/Images/maceoa.gif


  • aggression





















    • from http://lizzyforeal.files.wordpress.com/2008/05/catdrunk.gif

  • drugs and alcohol
      Some tips to help you get through the initial days:











      • Recognize the intensity of the experience, its very stressful nature, and that it is natural that you have a reaction.
      • Find supports to help you. Don't try to cope alone. This may be a family member, close friend, colleague, perhaps a counselor or your family doctor. Discussing what has happened is a way to begin to cope.
        • from http://www.kwikijoes.com/Dano_running_short.gif
      • Try to look after yourself by getting plenty of rest even if you can't sleep. Eating regular, nutritious meals. Exercise is a wonderful stress release.



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      15. Stress-Vulnerability Model of Psychosis

      There are multiple causative factors in the development of psychosis but most research suggests that the Stress-Vulnerability model of psychosis is the most dominant.
      from http://paularnoldwrite.eu/images/DNA_orbit_animated.gif
      This model suggests that a vulnerability to psychosis is acquired through a genetic predisposition or as a result of an environmental insult to the brain (e.g. head injury). This vulnerability, however, is not considered to be sufficient to manifest the disorder and must be 'triggered' by environmental processes. The environmental component can be biological (i.e. an infection, or even drugs and alcohol) or psychological (stressful living situation, school exams, travel etc.).

        from http://www.eyephysics.com/Madena/Pics/BrainAnimation.gif
      • vulnerability to psychosis is acquired through a genetic predisposition, or as a result of an environmental insult to the brain.
      • to manifest, the disorder must be 'triggered' by environmental processes
      • the amount of environmental stress needed to 'trigger' psychosis likely differs from person to person, as does the amount of vulnerability that at risk people have for psychosis.
        The 'stress' component of the model may take many forms, including:
      • Traumatic life events.
      • Use of drugs and alcohol.
        • from http://www.animation-station.com/money/animatedmoney/4612.gif
      • Stressful living conditions (e.g., low socioeconomic status; high levels of family conflict).


      DECREASED STRESS TOLERANCE
      from http://www.gifbin.com/bin/072010/1278324379_angry-daffy-duck.gif
      There is also some agreement that people with psychosis handle stress poorly. It seems that they have a low tolerance for stress - things that would have not been stressful for someone who does not have psychosis can prove too much for those who do have it. There is also a lower tolerance of intense emotions from others, e.g. anger, criticism, conflict or extremes in positive concern or over involvement. Clearly this makes knowing how far to push or encourage someone to do something a difficult decision. On the one hand too much pushing may lead to problems and even relapse, whereas no encouragement to do things may see someone sink into apathy and withdrawal.
      Certain factors can also reduce the risk that an at-risk person will develop psychosis:

      • Use of appropriate prescription medication.
      • Use of stress management techniques.
      • Reliable support systems (e.g., family, a hospital day program).
      THINGS FAMILY OR FRIENDS CAN DO:
      Learn to recognize what signs indicate a person needs time out:

      Decrease stimulation and decrease stress.
      Psychosis is a stress sensitive illness with a diminished tolerance of stress including lower tolerance for interpersonal relationships and stress common to family and friendship.

        from http://www.auburn.edu/~murraba/innov/door_animated.gif
      • Allow the person to close the door of their room.
      • Although the person may not be able to have a conversation; they can socialize by playing board games, cards, TV, movies, crafts, gardening.
      • Be reassuring - It's Ok if you get nervous, just sit with me for a while
      • Provide a structured and predictable environment.
      The recovering patient will have problems with sensory overload. In order to reduce stress plan activities for each day and keep big events to a minimum. Keep routines simple and allow the ill person time alone each day.

      Be consistent.
      Caregivers should agree on a plan of action and follow it. If you are predictable in the way you handle recurring concerns, you will help to reduce confusion and stress for the ill person.
      Maintain peace and calm at home.
      You will want to keep voices down and speak at a slower pace. Shorter sentences will also help to reduce stress. Avoid arguing about delusions (false beliefs).
      Together learn how to cope with stress.
      Anticipate ups and downs and prepare accordingly. A person with psychosis needs to learn how to cope with stress in a socially acceptable manner. Your positive role modeling will be most helpful.

      • Help your relative plan strategies for dealing with stress at events e.g. go to the washroom, outside for air, come late, leave early
      RESPONSES TO STRESS / HOW YOU KNOW YOU'RE STRESSED:
      Physiological: How the Body Responds

      Psychosocial: How the Mind Responds

      Behavioral: What You Do


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      14. WHAT CAN FAMILY, FRIENDS AND PSWs DO

        from http://www.gifninja.com/Workspace/539fa9fd-0ce4-43e7-ab43-2b2dcd45a19d/output.gif
      • Have the person assessed by a family doctor or mental health team.
      • Encourage the person to refrain from using any street drugs or alcohol as these may make their problems worse.
        • from http://www.graphicsgrotto.com/animatedgifs/alcohol/images/agalcohol2.gif
      • Try to keep an open line of communication with the troubled individual.
      • Be supportive and non-judgmental.
      • Avoid using critical comments.
        • from http://www.timkraft.net/bmp/one_bus_11-13-02_approx_5-50_pm/one_bus_11-13-02_approx_5-50_pm.gif
      • Focus on the specific problems that the person acknowledges, e.g. difficulties with sleep, concentration, appetite, taking the bus etc.
        • from http://arsonblog.files.wordpress.com/2009/06/2mewzlx-jpg.gif?w=255&h=184
      • If conversation seems to agitate the person, sitting together quietly may be helpful. Follow their cues.
      • This whole episode is probably frightening for the person. Offer comfort and reassurance, provide hope, and offer information that you know is accurate.
      • Try to decrease current stresses and lower the stimulation in the household. This might mean keeping television, stereo, or radio volume low, limiting the number of people in the home, lowering the lights, etc.
        • from http://www.toonupsnippets.com/thumb-medical_art_washing_hands.gif.350.c.gif
      • Behaviour problems such as neglecting hygiene, arguing, not complying with household rules etc. should be dealt with, perhaps one at a time. Set clear limits around acceptable behaviour and be clear about your expectations. Decide on consequences that are fair and related to the behaviour. Make sure that you enforce them. Be firm. Avoid arguments that will only escalate difficult behaviours. Remember that young people with mental health issues continue to require structure and limits, and a calm, predictable environment.
      • The troubled young person should be taught about how to manage stress. See the stress management section of the web site.
      ACUTE PSYCHOSIS STAGE
      from http://www.gifs-paradise.com/animated_gifs/doctors/animated-gifs-doctors-02.gif
      If your family member or friend is showing signs of psychosis (hallucinations, delusion, thought disorder) it is best to contact their psychiatrist or mental health worker. If they are not yet connected with a professional you have several choices. You may want to bring the person directly to the emergency department of your local hospital. Or, if you feel they can wait, call the mental health team in your region or your family doctor.
      HOW TO APPROACH SOMEONE YOU FEEL NEEDS HELP:

        from http://nataliaantonova.files.wordpress.com/2010/05/t2-loves-this-shit.gif
      • Individuals developing a psychotic condition will often not reach out for help. If you are concerned about an individual, you may have to approach him/her first.
      • Approach the individual you are concerned about in a caring and non-judgmental manner.
      • Specifically state why you are concerned.
        • from http://www.sccs.swarthmore.edu/users/06/adem/random/3D/images/animated/yaprak-mustafa-animated.gif
      • It is often best to state your concerns in behavioural terms.
        For example, "I have been concerned because you don't seem to be spending any time with your friends anymore."
      • Do not speculate on what their diagnosis might be. For example, do NOT state, "I am concerned that you might be getting psychotic."
      • Arrange to talk to the individual in a private setting.
      • If the individual is unwilling to talk with you, let them know that you will be available if they would like to talk with you in the future.
      • Ask if their family has expressed concern. Ask if they think it's okay for you to talk to the family.

      Some helpful hints for preparing for and attending an interview:


        from http://www.animationplayhouse.com/aapencildance.gif
      • Write down exactly what has been happening and what you have observed. Include what actions you may have taken up to now. Bring this with you.
      • Write down questions you may have (you'll probably find that you have more during the interview). Be persistent in asking your questions.
      • Take paper and pen with you to write down what is said so you don't have to rely on your memory afterwards.
      • Be realistic in your expectations. This is an initial meeting and more meetings may be scheduled. Change happens slowly.
      • Be sure to get a sense of when you will hear back about test results, followup, etc.

      Keep a list of who you see, when, why, what they say and what happens. It will give you the confidence to be sure that you have your thoughts in order when dealing with people who may not have the whole picture.
      WHAT WILL HAPPEN DURING AN ASSESSMENT for the individual concerned
      Whether you see your family doctor, a mental health clinic or a psychiatrist, it is likely that a range of information will be gathered. All mental health clinicians as well as physicians are guided by the rules of confidentiality. That means that whatever you discuss will remain confidential within the treatment team unless you agree to share the information with others such as a family member.
      A full history might include:


      The interviewer will ask more specifically about the presenting problem:

      • When did it start?
      • What was going on in the person's life at the time?
        • from http://www.doobix.com/images/graphics/friendster/school/animated/school_animated_58.gif
      • How did it affect their daily functioning (e.g. school/work, social life, family life)?
      • They will likely want to zero in on specific symptoms and ask about the presence of others not mentioned.
      • You may not be able to tolerate a full interview. Information can also be gathered more slowly over time.
      • If you agree, a family member may be asked to sit in on the interview at some point to help clarify information. This would be with the consent of the individual concerned.
        • from http://www.thecomedynet.com/wp-content/gallery/newimages5/Doctor_2.gif
      • A physician might then make a formulation of what appears to be happening and suggest treatment. It should also be suggested that the person have a complete physical examination.
      • It may not be clear that you have a psychiatric illness. Treatment may not be recommended. Instead, the physician or mental health worker might want to work with you to help you to deal with some of the issues that are troubling you.

      Help for family members:

        from http://www.funnercise.com/img/primer/06-cans-animated.gif
      • Recognize your stress level. Follow some of the hints in the stress management section of this web site.E.G. follow a nutritious, well-balanced diet, exercise regularly, try to get enough sleep. If you're calm, it will help to reduce stress in the household.
      • Educate yourself
      • Continue to connect with your friends and family. Let them support you and help ease the burden. Remember, psychosis is a brain disease, a physical illness manifesting itself in a psychological way. You are not to blame.
        • from http://www.doobybrain.com/wp-content/uploads/2010/02/pedala.gif
      • Continue to enjoy activities and hobbies.

      Managing Symptoms at Home
      HALLUCINATIONS (sensory experiences not shared by others)
      Possible Signs:
      • Pacing
      • Restlessness
      • Increased social withdrawal
      • Increased preoccupations
      • Irritability
      • Talking to oneself

      Coping Strategies:
      Work with the person to develop a strategy of what is helpful for them Identify and reduce what is causing them stress. See the doctor or mental health worker if necessary Help to provide distraction by:


      What Doesn't Work:
      • Attempts to reason or debate with the voices

      DELUSIONS (fixed, false beliefs: e.g. the person thinks they are Queen Elizabeth, or, that the radio is sending messages just to them; or that the RCMP is plotting against them)
      Possible Signs:


      Coping Strategies:


      Delusions are part of illness. Try to avoid emotional responses. Try to empathize with the fear, anxiety and distress.
      from http://www.gifnow.com/uploads/av/2009-04/thumbs/100x100_1240415164_confused_man.gif
      THOUGHT DISORDER (thoughts seem confused, disorganized, speeded up or slowed down)Possible Signs:


      What Helps:

      • Structured routine
      • Limits to behaviour
      • Simple words, short sentences
      • Ask the person to repeat the instructions you gave them
      • Lower the stimulation around them e.g. turn off radio, tv when speaking with them
      • Do not provide too many choices-too confusing

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